The Rich Get Richer: Osseous Chimeric Versatility to the Anterolateral Thigh Flap

2019 ◽  
Vol 36 (03) ◽  
pp. 171-176
Author(s):  
Jason W. Yu ◽  
Jordan D. Frey ◽  
Vishal D. Thanik ◽  
Eduardo D. Rodriguez ◽  
Jamie P. Levine
Keyword(s):  
Vascular System ◽  
Rectus Femoris ◽  
Anterolateral Thigh Flap ◽  
Common Trunk ◽  
Circumflex Artery ◽  
Separate Branch ◽  
Vastus Intermedius ◽  
Anterolateral Thigh ◽  
The Rich ◽  
Alt Flap

Abstract Background The lateral femoral circumflex artery (LFCA) system, which supplies the anterolateral thigh (ALT) flap territory, offers a plethora of tissue types for composite, functional reconstruction. However, the ability to include a reliable and flexible osseous component is limited. Based on cadaveric dissections, we describe an isolated LFCA branch to the femur separate from the vastus intermedius that can be included in ALT flap harvest in cases requiring bony reconstruction. Methods Cadaveric dissection was undertaken to define the LFCA vascular system with specific dissection of the proximal branches of the descending branch of the LFCA (db-LFCA) to define any muscular, periosteal, and/or osseous branches to the femur. Results Six thighs in four cadavers were dissected. Consistent in all specimens, there was an isolated branch extending distally, medially, and posteriorly from the proximal LFCA and entering the periosteum of the femur. In five specimens, the identified branch to the femur was located approximately 1-cm distal to the rectus femoris branch of the LFCA and approximately 1-cm proximal to a separate branch entering and supplying the vastus intermedius. In one specimen, there was a common trunk. The length of this branch from the origin at the LFCA to insertion into the femoral periosteum was approximately 6 to 8 cm. Conclusion There appears to be a consistent and reliable branch to the femur based on the proximal LFCA that may be included in ALT flap harvest, adding even more versatility, as another option in complex cases requiring composite reconstruction, including bone.

Color Doppler Ultrasound versus Computed Tomography Angiography for Preoperative Anterolateral Thigh Flap Perforator Imaging: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Reece Moore ◽  
Donna Mullner ◽  
Georgina Nichols ◽  
Isis Scomacao ◽  
Fernando Herrera
Keyword(s):  
Computed Tomography ◽  
Doppler Ultrasound ◽  
Computed Tomography Angiography ◽  
False Positive ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Preoperative Imaging ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background The anterolateral thigh (ALT) perforator flap is a commonly used flap with a predictable, though often variable, perforator anatomy. Preoperative imaging with color Doppler ultrasound (CDU) and computed tomography angiography (CTA) of ALT flap perforators can be a useful tool for flap planning. This study provides a complete review and analysis of the relevant preoperative ALT imaging literature. Methods Studies related to preoperative CDU and CTA imaging were reviewed, and information related to imaging method, sensitivity, false-positive rates, and perforator course identification (musculocutaneous vs. septocutaneous) were analyzed. Results A total of 23 studies related to preoperative ALT flap CDU and CTA imaging were included for review and analysis. Intraoperative perforator identification was compared with those found preoperatively using CDU (n = 672) and CTA (n = 531). Perforator identification sensitivity for CDU was 95.3% (95% CI: 90.9–97.6%) compared with the CTA sensitivity of 90.4% (95% confidence interval [CI]: 74.4–96.9%). The false-positive rate for CDU was 2.8% (95% CI: 1.1–4.5%) compared with 2.4% (95% CI: 0.7–4.1%) for CTA. Accuracy of perforator course identification was 95.5% (95% CI: 93.6–99.2%) for CDU and 96.9% (95% CI: 92.7–100.1%) for CTA. Conclusion CDU provides the reconstructive surgeon with greater preoperative perforator imaging sensitivity compared with CTA; however, false-positive rates are marginally higher with preoperative CDU. Preoperative imaging for ALT flap design is an effective tool, and the reconstructive surgeon should consider the data presented here when selecting a flap imaging modality.

scholarly journals Pedicled anterolateral thigh flap for contralateral groin composite defect

2010 ◽  
Vol 43 (01) ◽  
pp. 103-105
Author(s):  
S. P. Bharath ◽  
G. Madhusudan ◽  
Suraj Manjunath
Keyword(s):  
Free Flaps ◽  
Anterior Superior Iliac Spine ◽  
Anterolateral Thigh Flap ◽  
Wide Resection ◽  
Vascular Pedicle ◽  
Anterolateral Thigh ◽  
Vascular Compromise ◽  
Femoral Vessels ◽  
Alt Flap ◽  
Composite Defect

ABSTRACTPedicled anterolateral thigh flap has been well described for ipsilateral groin defects. Its versatility depends on the intact femoral vessels. When the external iliac and the femoral vessels are absent, especially secondary to wide surgical tumour ablations in the groin region, ipsilateral ALT flap is not an option. Free flaps also are difficult because of lack of recipient vessels. We report a case of composite groin defect following wide resection of recurrent liposarcoma along with encased vessels which was covered with a pedicled anterolateral thigh flap from the opposite thigh. The technique of lengthening the vascular pedicle and medializing the pedicle, to effectively increase its reach to the contralateral anterior superior iliac spine without vascular compromise, is described.

scholarly journals Chest wall reconstruction using a combined musculocutaneous anterolateral-anteromedial thigh flap

2010 ◽  
Vol 43 (01) ◽  
pp. 088-091
Author(s):  
Pearlie W. W. Tan ◽  
Chin-Ho Wong ◽  
Heng-Nung Koong ◽  
Bien-Keem Tan
Keyword(s):  
Soft Tissue ◽  
Chest Wall ◽  
Rectus Femoris ◽  
Musculocutaneous Flap ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Reconstruction ◽  
Wall Defect ◽  
Prolene Mesh ◽  
Anterolateral Thigh ◽  
Tissue Reconstruction

ABSTRACTWe present a massive 25 cm x 20 cm chest wall defect resulting from resection of recurrent cystosarcoma phyllodes of the breast along with six ribs exposing pleura. The chest wall was reconstructed with a Prolene mesh–methylmethacrylate cement sandwich while soft tissue reconstruction was carried out using a combined free anterolateral–anteromedial thigh musculocutaneous flap with two separate pedicles, anastomosed to the thoracodorsal and thoracoacromial vessels respectively. We explain our rationale for and the advantages of combining the musculocutaneous anterolateral thigh flap with the anteromedial-rectus femoris thigh flap.

A novel combination flap of anterolateral thigh flap (ALT) and rectus femoris flap for perineal defects

2015 ◽  
Vol 38 (6) ◽  
pp. 487-490
Author(s):  
Stefan Riml ◽  
Lorenz Larcher ◽  
Alexander Kozlowski ◽  
Michael Jakubietz ◽  
Jörg Gerhard Grünert
Keyword(s):  
Rectus Femoris ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh

scholarly journals Aesthetic and Functional Outcomes of the Innervated and Thinned Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Carlos Alberto Torres-Ortíz Zermeño ◽  
Javier López Mendoza
Keyword(s):  
Upper Extremity ◽  
Free Flaps ◽  
Sensory Function ◽  
Anterolateral Thigh Flap ◽  
Level Of Evidence ◽  
Average Percentage ◽  
Aesthetic Result ◽  
Anterolateral Thigh ◽  
Good Cosmetic ◽  
Alt Flap

Background. The anterolateral thigh (ALT) flap has been widely described in reconstruction of the upper extremity. However, some details require refinement to improve both functional and aesthetic results. Methods. After reconstruction of upper extremity defects using thinned and innervated ALT flaps, functional and aesthetic outcomes were evaluated with the QuickDASH scale and a Likert scale for aesthetic assessment of free flaps, respectively. Results. Seven patients with a mean follow-up of 11.57 months and average flap thickness of 5 mm underwent innervation by an end-to-end neurorrhaphy. The average percentage of disability (QuickDASH) was 21.88% with tenderness, pain, temperature, and two-point discrimination present in 100% of cases, and the aesthetic result gave an overall result of 15.40 (good) with the best scores in color and texture. Conclusions. Simultaneous thinning and innervation of the ALT flap lead to a good cosmetic result and functional outcome with a low percentage of disability, which could result in minor surgical procedures and better recovery of motor and sensory function. Level of Evidence. IV.

scholarly journals Salvage of a Near-Total Penile Amputation following Urinary Fistulization and Carbapenemase-Producing Klebsiella pneumoniae Infection with a Composite ALT Flap and Vascularized Fascia Lata

2021 ◽  
Vol 07 (03) ◽  
pp. e237-e240
Author(s):  
Ricardo Horta ◽  
Margarida Mendes ◽  
Diogo Barreiro ◽  
Alexandre Almeida ◽  
Mariana Jarnalo ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Wound Dehiscence ◽  
Fascia Lata ◽  
Anterolateral Thigh Flap ◽  
Salvage Procedure ◽  
Penile Amputation ◽  
Anterolateral Thigh ◽  
Circumferential Reinforcement ◽  
Complex Wounds ◽  
Alt Flap

AbstractReconstruction of complex penile defects is always challenging, as some defects are not possible to reconstruct with skin or mucosa grafts, and even local flaps may be precluded in complex wounds. We present a case of a 63-year-old otherwise healthy man, who underwent transurethral resection of the prostate for benign prostatic hyperplasia. After the procedure, he developed panurethral necrosis with consequent stricture. Three urethroplasties for reconstruction of the bulbar and distal urethra using buccal mucosa grafts, a preputial flap, and penile skin were performed by urology team in different institutions, but serious urinary fistulization and carbapenemase-producing Klebsiella pneumoniae (KPC) infection translated in a chronic wound, urethra necrosis, and near-total penile amputation. A composite anterolateral thigh flap and vascularized fascia lata were used with success together with a perineal urethroplasty in different stages, improving the ischemic wound condition. The extended segment of fascia lata was used for Buck's fascia replacement and circumferential reinforcement to cover the erectile bodies of the penis. The postoperative period was uneventful and after 12 months, there were no signs of recurrence or wound dehiscence. He was able and easily adapted to void in a seated position through the perineal urethrostomy that was made. To the best of our knowledge, this procedure has not been reported previously as a salvage procedure in a fistulizated and KPC infected penis, but it may be considered to avoid penile amputation in chronic infected and intractable wounds.

TO INVESTIGATE BRANCHED ANATOMICAL FEATURES OF THE LATERAL FEMORAL CIRCUMFLEX ARTERY USED IN THE CONSTRUCTION OF THE COMPOSITE ANTEROLATERAL THIGH (ALT) FLAP

2020 ◽  
pp. 89-98
Author(s):  
Phuc Le Hong ◽  
Son Tran Thiet ◽  
Khoa Tran Dang
Keyword(s):  
Femoral Artery ◽  
Descriptive Analysis ◽  
Circumflex Artery ◽  
Cross Sectional ◽  
Anatomical Features ◽  
Anterolateral Thigh ◽  
Lateral Femoral Circumflex Artery ◽  
Research Standards ◽  
Anatomical Research ◽  
Alt Flap

Introduction: The research of the lateral femoral circumflex artery has been studied and applied in many clinical fields. Objectives: To investigate branched anatomical features of the lateral femoral circumflex artery used in the construction of the composite anterolateral thigh (ALT) flap. Patients and research methods: 60 thigh areas of 30 Vietnamese adult cadavers meeting the research standards were conducted cross-sectional descriptive analysis. Result: lateral femoral circumflex artery usually has three branches that are ascending branch, oblique branch and descending branch. Descending branch usually separated independently (11.7%), oblique branch and ascending branch often have common body (83.3%). The majority of ascending branches have origin from lateral femoral circumflex (76.7%). Ascending branche has average of 4.1 branches to supply the anterior thigh muscles. Ascending branches has 2-3 cutaneous perforators were the majority (41.7%). There are 73 descending branch, 75.34% descending branch from the original branch of the lateral femoral circumflex artery, 8.22% lateral femoral circumflex artery from femoral artery and 16.44% descending branch from deep femoral artery. Averaging descending branch has 8.9 ± 0.2 branches to muscles of anteriolateral thigh area and on average had 3.1 ± 0.3 perforators per thigh specimen. The number of branches to lateralis muscles was at most 7.9 ± 0.4 branhes. Conclusion: Anatomical research of the lateral femoral circumflex artery branching as a premise to build a composite ALT flaps with lateralis component or with TFL makes sense in the creation of workhorse materials in clinical application. Key words: lateral femoral circumflex artery

scholarly journals Keystone Design Perforator Island Flap for Closure of the Anterolateral Thigh Flap Donor Site: a Case Series and Our Experience

2021 ◽  
Author(s):  
Feiyu Cai ◽  
Yanshi Liu ◽  
Kai Liu ◽  
Jiasharete Jielile ◽  
Aihemaitijiang Yusufu
Keyword(s):  
Donor Site ◽  
Case Series ◽  
Island Flap ◽  
Anterolateral Thigh Flap ◽  
High Survival ◽  
Anterolateral Thigh ◽  
Mean Size ◽  
The Mean ◽  
Alt Flap

Abstract Purpose: With the development of microsurgical techniques, the anterolateral thigh (ALT) flap has been widely used in reconstruction of various soft-tissue defects. However, there were few studies focusing on the closure of the ALT flap donor site, especially when the width of the harvested ALT flap was more than 6 cm. The purpose of this study was to share our experience of using Keystone Design Perforator Island Flap (KDPIF) to repair the ALT flap donor site where can’t be closed without a skin graft.Method: A retrospective study was used to analyze 12 patients who underwent the reconstruction of the ALT flap donor site using KDPIF from February 2018 to December 2020. Demographics, flap characteristics, surgical technique, postoperative complications, Vancouver Scar Scale (VSS) score, and Scar Cosmesis Assessment and Rating (SCAR) score were statistically analyzed.Results: 12 patients (10 males, 2 females) with the mean age 47.5 years (range, 27-66 years) were included in this study. All ALT flap donor sites were closed by the KDPIF. The mean size of the harvested ALT flap (the donor site size) was 8.1 cm × 14.4 cm (range from 8.0 cm × 11.0 cm to 9.0 cm × 21.0 cm), and the mean size of keystone flap was 9.1 cm × 16.4 cm (range from 8.0 cm × 13.0 cm to 12.0 cm × 19.0 cm). At the mean follow-up of 8.3 months (range, 6-12 months), two patients suffered from the skin infection around the flap, which was controlled under the treatment of wound dressing change and oral antibiotics. Wound dehiscence, osteofascial compartment syndrome (OCS), venous return disorder, and skin necrosis were not presented in any patients. All patients were evaluated at the final follow-up with ASS core (mean, 6.7; range, 5-8) and SCAR core (mean, 7.3; range, 6-9).Conclusion: This study demonstrated that the KDPIF that can be used to close the ALT flap donor site primarily is an effective and alternative treatment for patients with a the width of the donor site more than 6 cm including the advantages of high survival rate, low morbidity, good aesthetics, and simple operation.

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